The present invention relates to a medical dissection spatula having a shaft and a distal flat spatula end.
A dissection spatula of this kind is known from the catalog of Karl Storz GmbH and Co. entitled xe2x80x9cStorzxe2x80x94Die Welt der Endoskopiexe2x80x9d [Storzxe2x80x94the world of endoscopy], 2nd edition, chapter 7, 1/94, page NP 4 A, No. 28176 RE.
Dissection spatulas are used generally in surgery to remove tissue by splitting, cutting, or detaching the tissue from other tissue layers. The distal flat spatula end is used to separate tissue layers from one another, scrape off portions of tissue, or the like. A spatula of this kind can also be used to move a tissue or organ without damaging it.
Dissection spatulas of this kind are used, for example, in cosmetic surgery to detach fatty tissue beneath the skin, for example on the cheeks, in the region of the eyes, or in the region of the nasolabial fold.
The dissection spatula described in the Storz GmbH and Co. catalog under article number 28176 RE is a straight spatula whose shaft transitions into a distal, flattened, blunt spatula end.
To remove an area of tissue, the tissue must be separated from the surrounding tissue by splitting or scraping. This is done by inserting the spatula end between the tissue layers; the spatula is moved laterally back and forth, and the tissue to be removed is gradually detached by lifting the spatula. Only then can the tissue be scraped off or cut up.
Lifting and scraping is problematic with the straight dissection spatula described in the prior art, since the surrounding tissue must experience as little damage as possible, and the clearance for moving the spatula back and forth is therefore limited. Because of the rigid arrangement of the spatula end and the shaft, however, the entire spatula must be moved in order to effect lifting or scraping.
Against this background, it is the object of the present invention to make available a dissection spatula with which tissue or portions of tissue can be detached, split, or separated efficiently and with as little damage as possible, and with which directed manipulation can be ensured using simple means.
This object is achieved, by way of a medical dissection spatula of the kind cited initially, in that its spatula end has two spatula jaw parts, the spatula jaw parts being spreadable out away from the spatula surface.
Because of the presence of two spreadable spatula jaw parts, the target tissue can now be efficiently split by first bringing the spatula end, with the two spatula jaw parts in the unspread state, to the desired location. In the closed or unspread state, the dissection spatula operates like the dissection spatula cited initially that has only one spatula part. By simply spreading the spatula jaw parts in a direction away from the spatula surface, the tissue to be separated can then be lifted away from the surrounding tissue. The degree to which the two spatula jaw parts are spread depends on the size and extent of the tissue, so that the dissection spatula according to the invention is usable in many ways. If the dissection spatula is to penetrate even further into the tissue, the spatula jaw parts can be closed again and further regions can be separated by back-and-forth movement, and lifted away and detached from one another by spreading the spatula jaw parts again.
The provision of two spatula jaw parts that are spreadable and thus also closable moreover makes it possible to grasp tissue or, for example, also blood vessels. Body parts such as blood vessels or tendons can thus be displaced in order to gain access to tissue located behind them that is to be detached.
If two tissue layers are to be separated from one another over a large area, this can be accomplished with the spatula according to the present invention by introducing it between the two layers and repeatedly spreading the closed spatula jaw parts, and moving them back and forth, to the particular extent required.
With the dissection spatula according to the present invention, these advantages are achieved, without complex technical mechanisms, simply by the provision of two spreadable spatula jaw parts at the distal spatula end.
In a preferred embodiment of the dissection spatula according to the present invention, the two spatula jaw parts broaden toward their distal end.
The advantage here is that with a relatively broad end region, larger regions of tissue can be detached. When holding tissues or portions of tissue, for example muscles, tendons, or blood vessels, it is advantageous that this tissue can be held more securely and less traumatically with distally broadened spatula jaw parts than with narrow spatula jaw parts, since the holding pressure is distributed over a greater holding surface.
In a further preferred embodiment, the two spatula jaw parts rest congruently on one another in the unspread state.
The advantage of this embodiment is that in the unspread state, the dissection spatula can be used like a conventional spatula that requires little space upon introduction into tissue, but at the target location offers all the advantages resulting from spreading of the spatula jaw parts.
In a further preferred embodiment, the two spatula jaw parts are curved out of the shaft axis. In particular, they are curved out of the shaft axis over their entire length.
The advantage here is that the tissue layers, which are often not arranged in straight lines, can be reached better, and that tissue can be detached by scraping in particularly easy and efficient fashion. In facial operations, for example, the spatula jaw parts that are curved over their entire length can be placed against the curved cheekbones.
In a highly preferred embodiment, the transition between the shaft and the broadened spatula jaw parts is smoothly shaped.
This is particularly advantageous because the risk of injury during movement of the spatula is avoided, and nontraumatic dissection is thus possible.
In a further highly preferred embodiment, one of the two spatula jaw parts is joined immovably to the shaft, and the second spatula jaw part is joined movably to the shaft.
This embodiment makes it possible to work particularly safely with the dissection spatula according to the present invention, since spreading occurs with only one jaw part and thus only in one direction. For example, if two tissues are separated from one another by a soft skin or membrane, as is the case, for example, between connective and fatty tissue or between bone and connective tissue, the dissection spatula can be placed with the stationary spatula jaw part against the membrane that must not be damaged. The tissue that is to be separated from the first one is efficiently detached by spreading the one movable spatula jaw part.
This further facilitates handling for the operator because when the spatula jaw parts are closed, the dissection spatula works like a rigid, nonspreadable spatula, and the rigid spatula jaw part serves as a defined placement and guidance element from which, when necessary, the other spatula jaw part can be spread out. The rigid spatula jaw part remains at a specific point.
In a further preferred embodiment, each spatula jaw part has two blunt lateral edges and one blunt end edge.
It is particularly advantageous in this context that the dissection spatula according to the invention allows nontraumatic manipulation, i.e. in a manner that avoids injury. The fact that the spatula jaw parts have blunt boundaries all around prevents undesirable tearing or cutting of tissue that must be left undamaged.
In a further preferred embodiment, at least one spatula jaw part is equipped with a sharp end edge.
The advantage here is that the dissection spatula according to the present invention can also be used as a surgical knife or a scalpel, so that solid tissue areas can be cut with the respective end edge of the spatula jaw parts. For example, blood vessels can also be cut through, or solid connective tissue membranes can be cut off or cut into.
In a preferred embodiment, the end of the spatula jaw parts is configured with an approximately round profile.
This shape allows smooth penetration into the tissue.
In a further preferred embodiment, the end of the spatula jaw parts is configured with an approximately straight profile.
This embodiment has the advantage that scraping of tissue in the region of tissues with a flat configuration, for example on membranes, can be performed particularly efficiently.
In a highly preferred embodiment, the two spatula jaw parts are spreadable by way of an actuation element.
This has the advantage that in the case of a surgical operation in the human body, it is possible to control the movement of the spatula jaw parts from outside. The actuation element can, for example, be joined to the spatula jaw part via a pivot joint.
In a further preferred embodiment, the actuation element is arranged in the interior of the shaft.
It is advantageous in this context that the actuation element can be mounted in space-saving fashion, and in a manner that avoids additional corners and edges.
In a highly preferred embodiment, the shaft is joined to a handle that has one handle element joined immovably to the shaft and a second handle element joined in articulated fashion to the first handle element and in articulated fashion to the actuation element, the two spatula jaw parts being spreadable by moving the second actuation element.
This embodiment has the advantage that the surgeon on the one hand can securely hold the dissection spatula according to the present invention with two fingers of one hand, and at the same time can initiate spreading of the two spatula jaw parts by moving only one finger. This prevents uncontrolled slippage of the dissection spatula, and at the same time allows simple and easily controllable spreading to the particular desired extent.
In a further embodiment of the invention, the spreading direction of the spatula jaw parts extends approximately perpendicular to the movement plane of the second handle element.
The advantage of this feature is that the operator can advance the closed dissection spatula in one direction, and can move the handle elements relative to one another in the same direction, a harmonious operation that can also be superimposed. The spreading action, oriented approximately perpendicular thereto, effectively detaches the tissue parts from one another and then allows the spatula jaw parts, once closed again, to be advanced further. For example, in the performance of a facial operation in which the spatula jaw parts are advanced along the cheekbone toward the eye socket, the surgeon can gradually work forward, from outside via an incision, along the cheek toward the eye socket by advancing the dissection spatula and moving the handle elements in the same direction or in the opposite direction, and by spreading the spatula jaw parts can gradually detach, perpendicular to the advancement direction, those portions of tissue that are to be removed.
In a further embodiment of the dissection spatula according to the present invention, the entire spatula is arranged displaceably within a straight tubular shaft element, the inside diameter of the tubular shaft element corresponding approximately to the width of the two spatula jaw parts.
The tubular shaft element can be configured, for example, as a trocar.
With this embodiment, it becomes possible to use the dissection spatula according to the present invention in minimally invasive surgery as well, so that not only can the spatula be used in the dissection of superficial tissues, but access can also be gained, by introduction through a trocar, to organs or tissues located more deeply.
In a preferred variant of this embodiment, the two spatula jaw parts of the dissection spatula are configured in such a way that upon emerging from the tubular shaft element, they assume a curvature that projects laterally beyond the outer surface line of the tubular shaft element.
In this case the spatula jaw parts can be manufactured from a so-called xe2x80x9cmemory materialxe2x80x9d which has the property of reproducibly returning to a specific shape after any deformation. A highly resilient material, such as spring steel, can also be used. For example, the spatula jaw parts are approximately stretched out inside the tubular shaft element so as to fit inside the tubular shaft element, which is as narrow as possible. After being extended out from the tubular shaft element, however, the two spatula jaw parts are curved.
In a further embodiment, the dissection spatula is joined to an endoscope in such a way that the region between the two spatula jaw parts is visible.
The advantage here is that the surgeon can observe his or her manipulations with the spatula end directly, for example, via a monitor, thus making it possible to work in particularly directed fashion with the dissection spatula. An endoscope makes the surgeon""s work considerably easier, especially when the dissection spatula according to the present invention is introduced into body parts that are not located superficially.
It is particularly advantageous in this context if the endoscope is movable, in particular is rotatable, relative to the dissection spatula.
In this embodiment, it is possible to view various working areas of the dissection spatula through the endoscope or the endoscopic optical system, and to track, for example, the distal end of the spatula jaw part that is to be spread.
Further advantages are evident from the description below.
It is understood that the features mentioned above and those yet to be explained below can be used not only in the respective combinations indicated, but also in other combinations or in isolation, without leaving the context of the present invention.